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Original article

Vol. 147 No. 1112 (2017)

Estimating the incidence of traumatic spinal cord injuries in Switzerland: use of administrative data to identify potential coverage error in a cohort study

  • Jonviea D. Chamberlain
  • Elias Ronca
  • Martin W.G. Brinkhof
DOI
https://doi.org/10.4414/smw.2017.14430
Cite this as:
Swiss Med Wkly. 2017;147:w14430
Published
13.03.2017

Abstract

INTRODUCTION

Inferences from population-based cohort studies may be inaccurate as a result of biased coverage of the target population. We investigated the presence of absolute coverage error and selection bias in the Swiss Spinal Cord Injury (SwiSCI) cohort study, using a secondary, nationally representative data source. The proposed methodology is applicable to future Swiss cohort studies aiming to assess their coverage error.

METHODS

ICD-10 codes relating to traumatic spinal cord injuries (TSI) (S14.0, S14.1, S24.0, S24.1, S34.0, S34.1, S34.3, T.060, T.061, T.093, and T91.3) were used to identify incident TSCI cases in 2012 and 2013 from nationwide, administrative hospital discharge data collected by the Swiss Federal Statistical Office. The hospital discharge data were compared with SwiSCI data, and factors associated with receiving rehabilitation in a SwiSCI centre were statistically investigated. Age- and sex-specific incidence rates (IRs) were estimated using hospital discharge data. Different ICD-10 coding combinations were used in sensitivity analyses. Severity of spinal cord injury was characterised by lesion level (paraplegia or tetraplegia) and lesion completeness (complete or incomplete).

RESULTS

In total, 621 administrative cases, compared with 213 SwiSCI cases, were identified. The hospital discharge data differed from SwiSCI data with respect to age (p <0.01). The annual overall IR ranged between 19.9 and 49.7 per one million population, depending on the selection criteria used. Overall, IRs were elevated for men (compared with women), older age groups (compared with 16–30 year olds) and paraplegia (compared with tetraplegia). Men, younger persons and people with high tetraplegia (cervical vertebrae C1–C4) were more likely to visit a specialised rehabilitation centre.

CONCLUSION

There is undercoverage of incident TSCI cases in specialised rehabilitation centres in Switzerland, particularly among the elderly and persons with less severe TSCIs. The extent of coverage error indicated in the ICD-10-based sensitivity analyses can inform future modelling scenarios of national epidemiological estimates of TSCI.

References

  1. Asplund K, Bonita R, Kuulasmaa K, Rajakangas AM, Schaedlich H, Suzuki K, et al., World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease. Multinational comparisons of stroke epidemiology. Evaluation of case ascertainment in the WHO MONICA Stroke Study. Stroke. 1995;26(3):355–60. https://doi.org/10.1161/01.STR.26.3.355
  2. Giroud M, Lemesle M, Quantin C, Vourch M, Becker F, Milan C, et al. A hospital-based and a population-based stroke registry yield different results: the experience in Dijon, France. Neuroepidemiology. 1997;16(1):15–21. https://doi.org/10.1159/000109666
  3. David M, Ware R, Donald M, Alati R. Assessing generalisability through the use of disease registers: findings from a diabetes cohort study. BMJ Open. 2011;1(1):e000078. https://doi.org/10.1136/bmjopen-2011-000078
  4. Casey JA, Schwartz BS, Stewart WF, Adler NE. Using electronic health records for population health research: a review of methods and applications. Annu Rev Public Health. 2016;37(1):61–81. https://doi.org/10.1146/annurev-publhealth-032315-021353
  5. Post MW, Brinkhof MW, von Elm E, Boldt C, Brach M, Fekete C, et al.; SwiSCI study group. Design of the Swiss spinal cord injury cohort study. Am J Phys Med Rehabil. 2011;90(11, Suppl 2):S5–16. https://doi.org/10.1097/PHM.0b013e318230fd41
  6. WHO. International perspectives on spinal cord injury. Malta, World Health Organization, 2013.
  7. Chamberlain JD, Deriaz O, Hund-Georgiadis M, Meier S, Scheel-Sailer A, Schubert M, et al. Epidemiology and contemporary risk profile of traumatic spinal cord injury in Switzerland. Inj Epidemiol. 2015;2(1):28. https://doi.org/10.1186/s40621-015-0061-4
  8. Nijendijk JH, Post MW, van Asbeck FW. Epidemiology of traumatic spinal cord injuries in The Netherlands in 2010. Spinal Cord. 2014;52(4):258–63. https://doi.org/10.1038/sc.2013.180
  9. Database. Federal hospital discharge statistics database. Swiss Federal Statistical Office. 2012
  10. DeVivo MJ, Biering-Sørensen F, New P, Chen Y ; International Spinal Cord Injury Data Set. Standardization of data analysis and reporting of results from the International Spinal Cord Injury Core Data Set. Spinal Cord. 2011;49(5):596–9. https://doi.org/10.1038/sc.2010.172
  11. Swiss DRG. Regeln und definitionen zur fallabrechnung unter SwissDRG. 2015. Available from: http://www.swissdrg.org/assets/pdf/Tarifdokumente/SwissDRG_Falldefinitionen_Version_4.0_d_def.pdf
  12. Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011;34(6):535–46. https://doi.org/10.1179/204577211X13207446293695
  13. Mitchell B. A comparison of chi-suare and Kolmogorov-Smirnov tests. Area. 1971;3:237–41.
  14. Hagen EM, Rekand T, Gilhus NE, Gronning M. Diagnostic coding accuracy for traumatic spinal cord injuries. Spinal Cord. 2009;47(5):367–71. https://doi.org/10.1038/sc.2008.118
  15. Noonan VK, Thorogood NP, Fingas M, Batke J, Bélanger L, Kwon BK, et al. The validity of administrative data to classify patients with spinal column and cord injuries. J Neurotrauma. 2013;30(3):173–80. https://doi.org/10.1089/neu.2012.2441
  16. Smith GS, Langlois JA, Buechner JS. Methodological issues in using hospital discharge data to determine the incidence of hospitalized injuries. Am J Epidemiol. 1991;134(10):1146–58. https://doi.org/10.1093/oxfordjournals.aje.a116018
  17. Langley J, Stephenson S, Cryer C, Borman B. Traps for the unwary in estimating person based injury incidence using hospital discharge data. Inj Prev. 2002;8(4):332–7. https://doi.org/10.1136/ip.8.4.332
  18. Hilbe JM. Modeling Count Data. Cambridge University Press, 2014.
  19. Singh A, Tetreault L, Kalsi-Ryan S, Nouri A, Fehlings MG. Global prevalence and incidence of traumatic spinal cord injury. Clin Epidemiol. 2014;6:309–31.
  20. Sabre L, Pedai G, Rekand T, Asser T, Linnamägi U, Kõrv J. High incidence of traumatic spinal cord injury in Estonia. Spinal Cord. 2012;50(10):755–9. https://doi.org/10.1038/sc.2012.54
  21. Pérez K, Novoa AM, Santamariña-Rubio E, Narvaez Y, Arrufat V, Borrell C, et al.; Working Group for Study of Injuries of Spanish Society of Epidemiology. Incidence trends of traumatic spinal cord injury and traumatic brain injury in Spain, 2000-2009. Accid Anal Prev. 2012;46:37–44. https://doi.org/10.1016/j.aap.2011.12.004
  22. Gulati A, Yeo CJ, Cooney AD, McLean AN, Fraser MH, Allan DB. Functional outcome and discharge destination in elderly patients with spinal cord injuries. Spinal Cord. 2011;49(2):215–8. https://doi.org/10.1038/sc.2010.82
  23. Marti A, Reinhardt JD, Graf S, Escorpizo R, Post MWM. To work or not to work: labour market participation of people with spinal cord injury living in Switzerland. Spinal Cord. 2012;50(7):521–6. https://doi.org/10.1038/sc.2011.181
  24. Nas K, Yazmalar L, Şah V, Aydın A, Öneş K. Rehabilitation of spinal cord injuries. World J Orthop. 2015;6(1):8–16. https://doi.org/10.5312/wjo.v6.i1.8
  25. Chamberlain JD, Meier S, Mader L, von Groote PM, Brinkhof MW. Mortality and longevity after a spinal cord injury: systematic review and meta-analysis. Neuroepidemiology. 2015;44(3):182–98. https://doi.org/10.1159/000382079
  26. Appelros P, Högerås N, Terént A. Case ascertainment in stroke studies: the risk of selection bias. Acta Neurol Scand. 2003;107(2):145–9. https://doi.org/10.1034/j.1600-0404.2003.02120.x
  27. Consortium for Spinal Cord Medicine. Early acute management in adults with spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med. 2008;31(4):403–79. https://doi.org/10.1080/10790268.2008.11760744
  28. Tator CH, Duncan EG, Edmonds VE, Lapczak LI, Andrews DF. Neurological recovery, mortality and length of stay after acute spinal cord injury associated with changes in management. Paraplegia. 1995;33(5):254–62. https://doi.org/10.1038/sc.1995.58
  29. Parent S, Barchi S, LeBreton M, Casha S, Fehlings MG. The impact of specialized centers of care for spinal cord injury on length of stay, complications, and mortality: a systematic review of the literature. J Neurotrauma. 2011;28(8):1363–70. https://doi.org/10.1089/neu.2009.1151
  30. Aito S ; Gruppo Italiano Studio Epidemiologico Mielolesioni GISEM Group. Complications during the acute phase of traumatic spinal cord lesions. Spinal Cord. 2003;41(11):629–35. https://doi.org/10.1038/sj.sc.3101513
  31. Ronca E, Scheel-Sailer A, Koch HG, Metzger S, Gemperli A. Inpatient migration patterns in persons with spinal cord injury: A registry study with hospital discharge data. SSM Popul Health. 2016;2:259–68.
  32. Mehra T, Koljonen V, Seifert B, Volbracht J, Giovanoli P, Plock J, et al. Total inpatient treatment costs in patients with severe burns: towards a more accurate reimbursement model. Swiss Med Wkly. 2015;145:w14217. https://dx.doi.org/10.4414/smw.2015.14217
  33. Eggli Y, Desquins B, Seker E, Halfon P. Comparing potentially avoidable hospitalization rates related to ambulatory care sensitive conditions in Switzerland: the need to refine the definition of health conditions and to adjust for population health status. BMC Health Serv Res. 2014;14(1):25. https://doi.org/10.1186/1472-6963-14-25
  34. Burns EM, Rigby E, Mamidanna R, Bottle A, Aylin P, Ziprin P, et al. Systematic review of discharge coding accuracy. J Public Health (Oxf). 2012;34(1):138–48. https://doi.org/10.1093/pubmed/fdr054
  35. Fässler M, Wild V, Clarinval C, Tschopp A, Faehnrich JA, Biller-Andorno N. Impact of the DRG-based reimbursement system on patient care and professional practise: perspectives of Swiss hospital physicians. Swiss Med Wkly. 2015;145:w14080. https://doi.emh.ch/smw.ch/10.4414/smw.2015.14080
  36. Maynard FM Jr, Bracken MB, Creasey G, Ditunno JF, Jr, Donovan WH, Ducker TB, et al., American Spinal Injury Association. International standards for neurological and functional classification of spinal cord injury. Spinal Cord. 1997;35(5):266–74. https://doi.org/10.1038/sj.sc.3100432
  37. Textor J, Hardt J, Knüppel S. DAGitty: a graphical tool for analyzing causal diagrams. Epidemiology. 2011;22(5):745. https://doi.org/10.1097/EDE.0b013e318225c2be